焦虑障碍患者家属的情感表达与患者症状严重程度的相关性初探-现代医学

焦虑障碍患者家属的情感表达与患者症状严重程度的相关性初探

单位：1. 南京医科大学附属无锡精神卫生中心精神科, 江苏无锡 214151;
2. 苏州卫生职业技术学院附属苏州市中西医结合医院木渎人民医院精神科, 江苏苏州 215101;
3. 苏州卫生职业技术学院临床医学院, 江苏苏州 215009

关键词：焦虑障碍情感表达家属症状影响因素

分类号：R749.72

出版年·卷·期（页码）：2020·48·第十期（1268-1272）

摘要：

目的：探索我国焦虑障碍患者家属的情感表达方式及特性对患者症状的影响。方法：选取符合入组条件的焦虑障碍患者及其1名家属共211对研究对象，使用汉密顿焦虑量表（HAMA）、功能大体评定量表（GAF）评估患者病情严重程度和社会功能受损程度，用Camberwell家庭会谈表中文版评估家属情感表达方式和特性，按家属情感表达方式进行分组比较，对患者焦虑的可能影响因素进行最佳尺度回归分析。结果：高情感表达（HEE）家属占37.0%。HEE组患者年龄较低情感表达（LEE）组高（t=2.693，P=0.008），患者HAMA评分高于LEE组（U=-11.78，P<0.001），GAF评分低于LEE组（U=-11.62，P<0.001）；两组家属与患者关系构成不同（G=27.97，P<0.001）。情感表达特性方面，除批评、敌对和情感过分参入3个维度的差异外，HEE组赞扬和疾病认识低于LEE组（U=-3.63，P<0.001；U=-6.19，P<0.001），家庭监护水平、社会歧视对患者和家属的影响均高于LEE组（U=-2.96，P=0.003；U=-3.14，P=0.002；U=-3.90，P<0.001）。最佳尺度回归分析显示，家属情感表达方式和批评维度是影响患者HAMA评分的重要因素。结论：焦虑障碍患者家属的情感表达方式及对患者的批评，是患者焦虑症状严重程度的重要影响因素。

Objective: To explore the effects of the modes and traits of the expressed emotion(EE) of family members of patients with anxiety disorders on their symptoms. Method: A total of 211 couples of patients with anxiety disorders and one family member who met the eligibility criteria were selected for the study. Hamilton Anxiety Scale(HAMA) and Global Assessment Function(GAF) were used to assess the severity of the patients' condition and the degree of social impairment. The Camberwell Family Interview-Chinese Version was used to assess the modes and traits of the EE of family members. The data were compared in groups according to the mode of the EE of family members. Optimal scaling regression analysis was carried out on the possible factors affecting the anxiety symptoms of patients. Results: Family members with high expressed emotion(HEE) account for 37.0%. The average age of patients in the HEE group was higher than that in the low expressed emotion(LEE) group and the patients also had a higher HAMA score(t=2.693, P=0.008; U=-11.78, P<0.001). However, the GAF score was lower than that in LEE group(U=-11.62, P<0.001). The relationships between these two groups of family members and patients were different(G=27.97,P<0.001). From the aspect of the traits of the EE, apart from differences amongst the three dimensions of criticism, hostility and excessive involvement of emotions, the level of praise and awareness of diseases were lower in the HEE group(U=-3.63, P<0.001; U=-6.19, P<0.001) compared to the LEE group. However, the level of family care and the influence of social discrimination on patients and their families were higher than those in the LEE group(U=-2.96, P=0.003; U=-3.14, P=0.002; U=-3.90, P<0.001). As shown by the optimal scaling regression analysis, the modes and criticism dimensions of the EE of family members are the crucial factors that can affect the HAMA score for patients. Conclusion: The mode of the EE of family members of patients with anxiety disorders and their criticism for patients are important factors that influence the severity of anxiety symptoms in patients.

参考文献：

[1] SCHIMMELMANN B G,MENG H,KOCH E,et al.Expressed emotion and the outcome of child and adolescent psychiatric disorders[J].Fortschr Neurol Psychiatr,2003,71(10):517-526.
[2] WILLIAM W H 3rd,QUINTEN A W R, COBY G,et al.Does the level of expressed emotion(LEE) questionnaire have the same factor structure for adolescents as it has for adults?[J].Soc Psychiatry Psychiatry Epidemiol,2007,42(3):215-220.
[3] DE BERARDIS D,CAMPANELLA D,SERRONT N,et al.Insight and perceived expressed emotion among adult outpatients with obsessive-compulsive disorder[J].J Psychiatr Pract,2008,14(3):154-159.
[4] PRZEWORSKI A,ZOELLNER L A,FRANKLIN M E,et al.Maternal and child expressed emotion as predictors of treatment response in pediatric obsessive-compulsive disorder[J].Child Psychiatry Hum Dev,2012,43(3):337-353.
[5] SHIM M,KIM D W,YOON S,et al.Influence of spatial frequency and emotion expression on face processing in patients with panic disorder[J].J Affect Disord,2016,197(6):159-166.
[6] RENSHAW K D,CHAMBLESS D L,THORGUSEN S.Expressed emotion and attributions in relatives of patients with obsessive-compulsive disorder and Panic Disorder[J].J Nerv Ment Dis,2017,205(4):294-299.
[7] KONERU V K,DE MAMANI A G W.Acculturation and expressed emotion in Caucasian, Latino, and black relatives of patients with schizophrenia[J].J Nerv Ment Dis,2007,195(11):934-938.
[8] GURAK K,WEISMAN D M A,et al.Caregiver expressed emotion and psychiatric symptoms in african-americans with schizophrenia:an attempt to understand the paradoxical relationship[J].Fam Process,2017,56(2):476-486.
[9] HAMILTON M.The assessment of anxiety states by rating[J].Br J Med Psychol,1959,32(1):50-55.
[10] 张明园.精神科评定量表手册[M].2版.长沙:湖南科学技术出版社,1998:148-150.
[11] PHILLIPS M R,XIONG W.Expressed emotion in mainland China:Chinese families with schizophrenic patients[J].Int J Ment Health,1995,24(3):54-75.
[12] 张莉娟.焦虑症患者家庭的情感表达方式及其与症状复发的相关性研究[D].苏州:苏州大学,2004.
[13] GARCIA-LOPEZ L J,MUELA J M,ESPINOSA-FERNANDEZ L,et al.Exploring the relevance of expressed emotion to the treatment of social anxiety disorder in adolescence[J].J Adolesc,2009,32(6):1371-1376.
[14] GARCIA-LOPEZ L J,DIAZ-CASTELA M M,MUELA-MARTINEZ J A,et al.Can parent training for parents with high levels of expressed emotion have a positive effect on their child's social anxiety improvement?[J].J Anxiety Disord,2014,28(8):812-822.
[15] 方建忠,张莉娟,梅其一,等.神经症患者家庭情感表达方式与复发的相关性[J].中国临床康复,2006,10(10):22-25.
[16] HIRSHFELD D R,BIEDERMAN J,BRODY L,et al.Associations between expressed emotion and child behavioral inhibition and psychopathology:a pilot study[J].J Am Acad Child Adolesc Psychiatry,1997,36(2):205-213.
[17] CHAMBLESS D L,STEKETEE G.Expressed emotion and behavior therapy outcome:a prospective study with obsessive-compulsive and agoraphobic outpatients[J].J Consult Clin Psychol,1999,67(5):658-665.
[18] RAMIREZ A,PALACIO J D,VARGAS C,et al.Expressed emotions, burden and family functioning in schizophrenic and bipolar I patients of a multimodal intervention programme:PRISMA[J].Rev Colomb Psiquiatr,2017,46(1):2-11.
[19] CHRISTIANSEN H,OADES R D,PSYCHOGIOU L,et al.Does the cortisol response to stress mediate the link between expressed emotion and oppositional behavior in attention-deficit/hyperactivity-disorder(ADHD)?[J].Behav Brain Funct,2010,6(1):45.
[20] OS J V,MARCELIS M,GERMEYS I,et al.High expressed emotion:marker for a caring family?[J].Compr Psychiatry,2001,42(6):504-507.
[21] DOMINGUEZ-MARTINEZ T,MEDINA-PRADAS C,KWAPIL T R,et al.Relatives' illness attributions mediate the association of expressed emotion with early psychosis symptoms and functioning[J].Psychiatry Res,2014,218(1-2):48-53.
[22] BADER S H,BARRY T D.A longitudinal examination of the relation between parental expressed emotion and externalizing behaviors in children and adolescents with autism spectrum disorder[J].J Autism Dev Disord,2014,44(11):2820-2831.
[23] GONZALEZ-BLANCH C,GLEESON J F,COTTON S M,et al.Longitudinal relationship between expressed emotion and cannabis misuse in young people with first-episode psychosis[J].Eur Psychiatry,2015,30(1):20-25.
[24] RIENECKE R D,RICHMOND R L.Psychopathology and expressed emotion in parents of patients with eating disorders:relation to patient symptom severity[J].Eat Disord,2017,25(4):318-329.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录